Association between Screen Time and Sociodemographic Factors, Physical Activity, and BMI among Children in Six European Countries (Feel4Diabetes): A Cross-Sectional Study.

Screen time among children in most European countries is notably high and is influenced by various sociodemographic and other factors. Our study aimed to explore the associations between parents' sociodemographic characteristics, socioeconomic status, body mass index (BMI), physical activity, risk status for type 2 diabetes, and their children's BMI, physical activity, and screen time. The data were sourced from the 2016 Feel4Diabetes study, involving 12,280 parents and 12,211 children aged 6-9 years (average age 8.21 years) in a cross-sectional study design. We used a logistic regression model to identify potential factors associated with children's screen time. The results showed that mothers with tertiary education (OR = 0.64; 95%CI = 0.49-0.82; p < 0.001), the middle age group (45-54 years) (OR = 0.81 95%CI = 0.66-0.98; p = 0.033), and families with higher incomes (middle-OR = 0.85; 95%CI = 0.75-0.97; p = 0.014; high-OR = 0.8; 95%CI = 0.69-0.93; p = 0.003) were associated with a decreased chance of children spending more than 2 h/day in front of the screen. In contrast, maternal overweight/obesity (OR = 1.15; 95%CI = 1.03-1.29; p = 0.013) and lower physical activity in children were linked to an increased likelihood of more than 2 h of screen time per day. Our findings suggest that targeted interventions should be developed to mitigate excessive screen time, particularly focusing on low-income families and mothers with low educational levels.

Knowledge, attitude, and practice on antibiotics use among healthcare workers: A cross-sectional study in Niger state, Nigeria.

Introduction: Antibiotic resistance is a public health concern in Nigeria and the world, and healthcare workers contributed to the upsurge of antibiotic resistance in hospital settings. This study focused on the knowledge, attitude, and practice (KAP) of antibiotic use and the frequency of prescriptions of antibiotics from the list of WHO Model Essentials Antibiotics (AWaRe) (in the last 6 months) among healthcare workers and established the determining factors in six hospitals in Niger state, Nigeria. Methodology: A KAP survey was conducted in Niger State, Nigeria, from March to June 2022. A structured self-administered, pretested questionnaire was distributed to six hospitals in the state following a stratified random sampling considering the staff capacity, the population of the city, and patients' patronage. Results: A total of 350 questionnaires distributed, and 313 (89.4%) completed and returned from the six hospitals. The median scores were knowledge (75%), attitude (69%), practice (62%), and self-reported prescription (70%), and respondents with good scores were knowledge [195 (62.3%)], attitude [185 (59.1%)], practice [201 (64.2%)], and prescription [117 (37.4%)]. In multivariate analysis, older respondents are more likely to have a good prescription (p = 0.006), and prior antimicrobial training improved their knowledge (p < 0.001), attitude (p = 0.007), and prescription pattern (p = 0.009). All the study participants had prescribed one or more of the most prescribed antibiotics; Amoxicillin clavulanate (Access group, 96.5%), Amoxicillin (Access group, 95.9%), and Metronidazole (Access group, 95.7%). Conclusions: The study suggests that antibiotic education for healthcare workers and antimicrobial stewardship programs are significant interventions to mitigate antibiotic overuse in the state.

Breast cancer screening and its associating factors among hungarian women aged 45-65: a cross-sectional study based on the European health interview surveys from 2009 to 2019.

BACKGROUND: In 2020, globally 685,000 people died, and 2.3 million women were diagnosed with breast cancer. The main cause of cancer deaths among women is breast cancer, which account for 15.5% of all cancer deaths. Most of these could have been avoided with timely diagnosis. The aim of our study was to determine the proportion of breast screening participation in Hungary, and to identify possible factors that may influence breast screening attendance. METHODS: Our data were gathered from the cross-sectional European Health Interview Surveys conducted in Hungary in 2009, 2014, and 2019. In terms of categorical characteristics, Pearson's chi-square test was performed to evaluate the differences between people who have attended breast screening within two years and who have only attended more than two years ago. To determine the factors that may have an impact on the uptake of screening, generalized linear model with logit link function regarding binomial probability distribution was executed. RESULTS: The responses of 2626 women between the age 45-65 were included in our study. In 2009 85% (n=741), in 2014 90% (n=851) and in 2019 87% (n=699) of the respondents claimed to have ever attended a breast screening in their life. In 2009 68% (n=594), in 2014 66% (n=630) and in 2019 64% (n=515) said that they have taken part in breast screening within two years (p=0.331). From 2014 to 2019 (AOR=0.72 [0.57-0.89]) the chance of attending breast screening was decreasing. We observed that both secondary (AOR=1.97 [1.60-2.44]) and tertiary educational level (AOR=2.23 [1.67-3.00]), higher perceived income (AOR=1.54 [1.25-1.90]), and more frequent meeting with the doctor (AOR=1.77 [1.39-2.27]) and with the specialist (AOR=1.88 [1.54-2.28]) appeared as protective factors of breast screening attendance. CONCLUSIONS: Our results show that the lifetime prevalence of breast screening participation is high, however the recommended biennial rate is relatively low. To increase the participation rate, various initiatives would be needed, especially for women in identified risk groups, which are lower educational level, lower perceived income, and less frequent meeting with the doctor and with the specialist.

Patients' Assessment of Chronic Illness Care (PACIC): Validation and Evaluation of PACIC Scale among Patients with Type 2 Diabetes in Hungary.

Introduction: The aims of this study were to evaluate the psychometric properties of the Hungarian translation of the PACIC in a sample of patients with type 2 diabetes and to reveal the associations between the mean PACIC scores and the number of chronic diseases, or visits to GPs, and specialist. An exploratory factor analysis (EFA) has also been performed to test the structural validity of the PACIC scale. Methods: The Hungarian version of PACIC was validated using randomly selected patients with type 2 diabetes (N = 684) from licensed GP practices. Results: Floor (1.6%-30.2%) and ceiling effects (11.3-33.6%) were similar of the PACIC scale. The internal consistency of the total scale (Cronbach's alpha 0.93) was excellent and subscales were good (between 0.73-0.9). The mean scores of each PACIC subscale group were between 2.99-3.53. There was a weak significant correlation between the mean PACIC scores of subscales and the number of GP visits (p < 0.001), and specialist visits (p < 0.001). The EFA identified four factors on the sample (KMO = 0.931). Gender and education showed correlation with some new factors. Conclusion: The psychometric properties of the Hungarian version of PACIC questionnaire showed a reasonable level of validity among patients with type 2 diabetes. Now, this instrument is ready to assess the chronic care of diabetic patients in Hungary.

[Retrospective examination of the Hungarian breast and cervical cancer screening programmes according to mortality and morbidity data]. / A magyarországi emlo- és méhnyakszurés retrospektív vizsgálatának jellemzoi a halálozási és megbetegedési adatok tükrében.

Introduction: The organized breast and cervical screening programs were implemented in the framework of public health program in Hungary in order to reduce breast cancer mortality by 30% and cervical cancer mortality by 60% in given age groups within 10 years by 2012. Aim: The aim of our study was to conduct a retrospective analysis of mortality and morbidity data and to evaluate the effectiveness of the implemented screening programs. Method: Descriptive statistical analysis was performed by age-standardized mortality and morbidity data between 1980 and 2015 with special regard to the period of 2002-2012. Results: Breast cancer mortality of women aged 45-64 reduced by 28.3%, the incidence reduced by 23.6% and the incidence of in situ carcinoma increased by 242% between 2002 and 2012. Cervical cancer mortality of women aged 25-64 years reduced by 25.5%, the incidence reduced by 21.2%, and the incidence of in situ carcinoma increased by 13.3% during 2002-2012. Conclusion: Although both breast cancer and cervical cancer mortality substantially decreased in Hungary, the decrease in cervical cancer did not reach the target value. Orv Hetil. 2019; 160(49): 1948-1956.

Impact of sense of coherence and work values perception on stress and self-reported health of midwives.

OBJECTIVE: The aim of the research was to explore how sense of coherence (SOC) and work values (WVs) impact on stress and perceived health of midwives. Sense of coherence, by definition, reflects a person's view of life and capacity to respond to stressful situations. A further goal was to evaluate the mediating effect of WVs between stress and health. DESIGN: A cross sectional, correlational design was used. SETTING: Participants were randomly selected from 13 hospitals across Hungary. PARTICIPANTS: The final sample included 228 midwives. METHODS: Main measures included Sense of Coherence Questionnaire, stress subscale from the Demand-Control-Support scale, Super's Work Values Inventory and Subjective Health Test developed by the authors. Statistical analyses determined correlation coefficients, difference by independent t-test, and linear regression. FINDINGS: Participants reported high level of stress, showed average SOC and subjective health. The most preferred work values were altruism (Mean = 12.40), economic returns (Mean = 12.11) and supervisory relations (Mean = 11.99). SOC and health were positively (r = 0.47, p < 0.001), while SOC and stress were negatively associated (r = -0.36, p < 0.001). WVs indirectly mediated the relationship between health and stress (r = -0.55, p < 0.001). Midwives who worked less than 5 years in practice did not differ on health, stress, WVs and SOC from those who had been working longer. Going from worst to best perceived personal health increased intention to stay in midwifery by 32% in the linear regression model. KEY CONCLUSIONS: In this study we documented relatively greater levels of stress and average levels of health and SOC among midwives. This paper confirmed that SOC had a positive impact on stress and health specifically for midwives. Uniquely, work values indirectly influenced the relationship between stress and health. IMPLICATIONS FOR PRACTICE: Improving SOC and WVs advance the health of midwives which will reduce the probability of leaving the profession.

Use of complementary and alternative medicine among breast cancer patients in Hungary: A descriptive study.

BACKGROUND AND PURPOSE: This study aimed to explore the prevalence of the use of complementary and alternative medicine (CAM) before diagnosis and during oncology therapy, and reveal the disclosure of CAM use among Hungarian breast cancer patients. MATERIALS AND METHODS: In a cross-sectional survey a self-administered questionnaire was used covering patients' demographics, oncology-related variables and various aspects of CAM use. Data were collected from 135 patients. Data analysis included descriptive analysis and Chi-square tests. RESULTS: The prevalence of CAM use was 52.6% before diagnosis while it was 84.4% during therapy. The most commonly used CAM practices before diagnosis and during therapy were vitamins/minerals (37%, 60%, respectively) and herbs (31.9%, 78.5%, respectively). The frequency of CAM use before diagnosis was higher among more educated patients (p < 0.001) and those living in cities (p = 0.001) while during therapy it was higher among patients with higher income (p = 0.020). Over 40% of the patients informed their physician about each CAM practice they used. CONCLUSION: Besides conventional medicine, CAM practices are also regarded as an important part of therapy by cancer patients. The higher frequency of CAM use during therapy and the relatively modest disclosure towards physicians indicate a greater need for patients' education regarding CAM practices.

Socioeconomic status, health related behaviour, and self-rated health of children living in Roma settlements in Hungary.

OBJECTIVE: The poor health of Roma is well documented, but there is only limited data regarding the health of Roma children. The aim of this study was to describe the socioeconomic status, health related behaviour, and health of children living in segregated Roma settlements, and to compare the data with that of non-Roma children. METHODS: In March-April of 2011, a cross-sectional questionnaire-based survey among 11-year-old (211 boys and 252 girls) and 13-year-old (205 boys and 247 girls) children living in Roma settlements was performed (response rate: 91.5%). These data were compared with data from the Health Behaviour in School-Aged Children (HBSC) survey carried out in 2009/2010. RESULTS: The parents of Roma children were substantially less educated and less likely to be actively employed, and Roma children reported lower material welfare than non-Roma ones. The prevalence of consuming sweets and soft drinks at least 5 times per week was 1.5-2 times higher among Roma children. The prevalence of regular intense physical activity was higher at the age of 13 years among Roma boys, while physical inactivity was substantially higher in both age groups among Roma girls. Almost one quarter of Roma children and approximately 14% of non-Roma children had tried smoking at the age of 11. More Roma boys tried alcohol at the age of 11 than non-Roma ones. One in ten Roma children was obese in both age groups. The self-rated health status of Roma children was worse than that of non-Roma children. CONCLUSIONS: Children living in Roma settlements reported poorer socioeconomic conditions, higher consumption of sweets and soft drinks, earlier smoking and alcohol initiation, and worse self-rated health, but with some exceptions do not differ in fruit or vegetable consumption and BMI from general child population. To promote health of children living in Roma settlements, a multi-sector approach, special health education, plus social and health promotion programmes are needed.

Health care for irregular migrants: pragmatism across Europe: a qualitative study.

BACKGROUND: Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries. RESULTS: Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this. CONCLUSIONS: The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.

Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study.

BACKGROUND: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. METHODS: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. RESULTS: The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. CONCLUSIONS: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries.

BACKGROUND: Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care. METHODS: Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis. RESULTS: Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services. CONCLUSIONS: Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.

Method validation for the simultaneous determination of fecal sterols in surface waters by gas chromatography-mass spectrometry.

Besides microbiological methods, fecal pollution of surface waters is estimated by gas chromatographic (GC) determination of sterols present in human and animal sewage effluents. The most frequently used biomarkers for the evaluation of contamination levels include coprostanol, cholesterol, dihydrocholesterol, stigmasterol, beta-sitosterol, and stigmastanol. Although several GC techniques are used to measure these compounds in aquatic systems, the analytical performance of GC-mass spectrometric (MS) determination of these sterols has not been systematically characterized. Therefore, the aim of this work is to validate a simple and rapid GC-MS method for the simultaneous analysis of six sterols, considering all parameters and requirements defined by Good Laboratory Practice. Following liquid-liquid extraction of spiked surface water samples, the extracts are silylated and analyzed by GC-MS. The method is evaluated for linearity and limits of detection and quantitation, as well as for precision, extraction efficiency, and stability. The assay is linear up to 160 ng; the limits of detection and quantitation are 5-10 ng and 20 ng, respectively. The within- and between-day precision ranged from 1% to 9% and 1% to 16%, respectively. The extraction efficiency was 65-80%. The stability studies indicate that the sterols in surface water samples begin to degrade after 24 h of refrigerated storage. However, three freeze/thaw cycles could be performed without their decomposition. The method is applied to the analysis of surface water and wastewater samples. The technical advantages make this GC-MS analysis suitable for routine environmental monitoring of fecal pollution in aquatic systems.

The composition of surrogate alcohols consumed in Russia.

BACKGROUND: In the course of a case-control study examining determinants of premature death among working age men, it became clear that a significant percentage of the population (7.3%) were drinking a variety of surrogate alcohol products (products not legally sold for consumption). In this population, where there is a high death rate from alcohol-related causes, including acute alcohol poisoning, it was important to know what these products contained. METHODS: The identity of products being consumed was identified from the survey of controls. Representative samples were obtained and subjected to analysis using gas chromatography and mass spectrometry to determine their composition. RESULTS: Three broad groups of product were identified: samogon (home-produced spirits); medicinal compounds; and other spirits (mainly sold as aftershaves). Commercially produced vodkas were used for comparison. Samogon contained lower quantities of ethanol than vodka [mean, 39 vs. 44 volumetric percentage (v/v%), respectively] but in addition contained certain toxic long-chain alcohols. Medicinal compounds contained only ethanol, at a higher concentration that vodka (mean, 66 v/v%), while the other spirits, which were also essentially pure ethanol, contained a mean of 94 v/v%. CONCLUSIONS: A significant number of Russian men are drinking products that have either very high concentrations of ethanol or contaminants known to be toxic. These products are untaxed and thus much less expensive than vodka. There is an urgent need for policy responses that target their production and consumption.

Could the high level of cirrhosis in central and eastern Europe be due partly to the quality of alcohol consumed? An exploratory investigation.

BACKGROUND: The burden of alcohol-related diseases differs widely among countries. Since the 1980s, a band of countries in Central and Eastern Europe have experienced a steep rise in deaths from chronic liver diseases and cirrhosis. A possible risk factor is the consumption of illegally produced home-made spirits in these countries containing varying amounts of aliphatic alcohols and which may be hepatotoxic. However, little is known about the composition of such beverages. AIMS: To compare the concentration of short-chain aliphatic alcohols in spirits from illegal and legal sources in Hungary. DESIGN: Samples taken from commercial retailers and illegal sources were collected and their aliphatic patterns and alcohol concentrations were determined by gas chromatographic/mass spectrometric (GC/MS) analysis. FINDINGS: The concentrations of methanol, isobutanol, 1-propanol, 1-butanol, 2-butanol and isoamyl alcohol were significantly higher in home-made spirits than those of from commercial sources. CONCLUSIONS: The results suggest that the consumption of home-made spirits is an additional risk factor for the development of alcohol-induced cirrhosis and may have contributed to high level of liver cirrhosis mortality in Central and Eastern Europe. Restrictions on supply and sale of alcohol from illicit sources are needed urgently to reduce significantly the mortality from chronic liver disease.

Possible role of factor XIII subunit A in Fcgamma and complement receptor-mediated phagocytosis.

Besides its traditional role in hemostasis, factor XIII subunit A (FXIII-A) is supposed to function as a cellular transglutaminase and to be involved in certain intracellular processes, including cytoskeletal remodeling. To investigate its intracellular role, the aim of the present study was to follow changes in FXIII-A production in combination with the receptor-mediated phagocytic activities of monocytes/macrophages and to examine the phagocytic functions of monocytes in patients with FXIII-A deficiency. Human blood monocytes were isolated from the buffy coats of healthy volunteers and cultured for 4 days. The FcgammaR-mediated phagocytosis of sensitized erythrocytes (EA) and the complement receptor (CR)-mediated phagocytosis of complement-coated yeast particles were studied during monocyte/macrophage differentiation. Changes in the gene expression of FXIII-A were detected by real-time quantitative RT-PCR. FXIII-A protein production was investigated with fluorescent image analysis at single cell level and Western immunoblot analysis. Both the FcgammaR and CR-mediated phagocytosis increased during culturing, which peaked on day 3. The phagocytic activity of the cells could be markedly inhibited with monodansylcadaverine, an inhibitor of the transglutaminase-induced crosslinking of proteins. The phagocytosis of EA, complement-coated and uncoated yeast particles was found to be strongly diminished in monocytes of FXIII-A deficient patients. The phagocytic functions of cultured cells showed a change in parallel with the alterations in FXIII-A mRNA expression, as well as with that in FXIII-A in protein synthesis detected by image and Western immunoblot analyses in concert. Our results suggest that FXIII-A plays a role in the Fcgamma and complement receptor-mediated phagocytic activities of monocytes/macrophages.

Simultaneous determination of styrene, toluene, and xylene metabolites in urine by gas chromatography/mass spectrometry.

Exposure to styrene, toluene, and xylene (STX) frequently occurs in various industrial settings leading to several adverse health effects. Therefore, the biological monitoring by determination of urinary mandelic acid (MA) and phenylglyoxylic acid (PGA), hippuric acid (HA), and 2-, 3-, and 4-methylhippuric acids (2-, 3-, and 4-MHAs), the metabolites of STX, is required or at least recommended in case of workers exposed by these agents. Considering the fact that co-exposure to STX frequently occurs, methods that have been described for the separate analysis of these compounds in urine samples cannot be used effectively for monitoring. Therefore, a reliable gas chromatographic/mass spectrometric (GC/MS) method was developed for the simultaneous identification and quantification of these metabolites. Following solid phase extraction of the urine samples, the extracts were silylated and analyzed by GC/MS using a HP-5MS capillary column. The method was evaluated for linearity, limits of detection and quantification, and specificity, as well as for precision, extraction efficiency, and stability at three different concentrations prepared in urine. The assay was linear up to 0.16 mg/ml for MA, and 0.32 mg/ml for PGA, HA, and 2-, 3- and 4-MHAs. The limits of detection and quantification of STX metabolites varied between 0.001 and 0.02 mg/ml, and from 0.01 to 0.04 mg/ml, respectively. The within-day and between-day precision, determined at low, medium, and high concentrations, ranged from 2 to 12% and 2 to 19%, respectively. The extraction efficiency was 70-80%. No degradation of the metabolites occurred in the urine samples under the possible working conditions. The method was applied for the analysis of the urine samples from exposed workers. The cost- and time-effectiveness, the technical advantages and validity parameters of this GC/MS analysis make it suitable for biological monitoring of mixed exposure to styrene, toluene and xylene.

Optimal flattening filter shape of a surface brachytherapy applicator.

As an alternative to standard treatment of superficial lesions with surgery and/or superficial/orthovoltage x-ray irradiation, radioactive moulds can be used. However, close proximity of the source to the treatment region leads to significant dose inhomogeneities in the tissue. Analytical and fast numerical methods have been developed that can calculate a corresponding flattening filter that evens out the dose distribution at the surface. Monte Carlo transport calculations were used to enable accurate treatment of the transport through the geometry. It was found that the use of pre-calculated transport parameters like dependence of the attenuation coefficient and scattering with depth is required for fast calculation of the flattening filter shape. Only 1-2 iterations were needed for a successful convergence to the filter shape that flattens out the dose distribution at the surface to within 1%. The developed methods are very general and could be applied with some minor modifications to other problems, where shaping of the irradiation field is required.